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Outcome Based Benefit Management

Outcome Based Benefit Management. Getting the Right Care at the Right Time Presenters: Dr. David Kendrick, MD, MPH, OU and CEO MyHealth Access Kim Owen, QuikTrip Corporation. General Themes - Healthcare Today. Costs must stabilize or go down More OK patients need access to care

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Outcome Based Benefit Management

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  1. Outcome Based Benefit Management • Getting the Right Care at the Right Time • Presenters: • Dr. David Kendrick, MD, MPH, OU and CEO MyHealth Access • Kim Owen, QuikTrip Corporation

  2. General Themes - Healthcare Today • Costs must stabilize or go down • More OK patients need access to care • As Purchasers demanding more quality, and proof thereof; • Will make purchasing decisions and policy accordingly • Readmissions • Medical errors • Duplication of services • Bottom line: Must deliver a higher quality product to more people for less $$$ per person

  3. Better Care-Better Cost • Better care • Better results • At a lower cost • Reduce unnecessary repeated tests • Lower number of referrals to specialists • Reduce the delays in getting specialized care • Don’t pay for 30 day “readmits” • Identify trends in your population • Right Care, Right Time, Right Amount= Better Outcomes

  4. How To Accomplish in a Broken System • Need More Information • Need Health Information Shared with ALL Treating Providers • Need Data to Know Who Is At Risk

  5. What is MyHealth Access Network? • A non-profit organization - grass roots, community-driven effort • Focused on a common objective • To improve the health of our community by improving the Oklahoma healthcare system • For the benefit of all patients, employers, and providers • A “healthcare public utility” to improve our work and improve our health

  6. Why Is MyHealth Interested • MyHealth is infrastructure only = wires • Does not provide patient care • Exists as a public utility to • Support • Enhance • Extend The care and services its member organizations can provide • Charged with improving Oklahoma health

  7. Oklahoma only state where death rate has gotten worse….. Some Factors • Economic downturn healthy people and jobs left Oklahoma • Poverty remained • Heart Disease – (Diabetes) • Cancer • Access to Care • Obesity Age-adjusted Death Rates Past 25 Years

  8. 2009 State of the State’s Health Summary • Oklahoma Grade Card – F • Cerebrovascular deaths, Chronic Lower Respiratory deaths, and Unintentional Injury deaths • Overall Mortality per 100,000 • OK – 918.7 • US – 799.4 • Proper Nutrition and Physical Activity • Current Smoker – 25.8% vs.19.8%

  9. …And its not because we are not spending enough money on healthcare

  10. What is the problem? • We have; • High quality doctors and hospitals. • Often nationally ranked and recognized • Extensive network of safety net clinics • active and engaged philanthropic community But . . . • We also have; • highly fragmented healthcare system • Patients see doctors in separate health systems • Clinics serving the poor often left out of communications • The left hand often doesn’t know what the right hand is doing

  11. Three tools • Electronic Medical Records (EMRs) are important, but . . . • Health Information Exchanges (HIEs) provide immediate benefit and greater cost savings through efficiency • Community-wide care coordination will provide better outcomes and cost savings

  12. MyHealth: Beacon Objectives Three required categories: • Cost Control • Quality Improvement • Population Health All supported by the implementation of specific Health IT interventions

  13. Cost Control • Reduce inappropriate utilization • Duplicated Labs (outpatient) • HbA1c: 16% of tests duplicated • Cholesterol tests: 22% • Microalbuminuria: 37% • Imaging (X-ray, CT, MRI) • New onset low-back pain: 32.3% of tests unnecessary • Hospitalizations • 30-day Medicare readmissions: 18% • Admissions for asthma, COPD, CHF: 2,000 per year • Use of ER’s instead of PCP visits

  14. Quality Improvement • Improve management of diabetes • Patients with annual eye exam: 38% • Patients with blood sugar in control: 37% • Patients with cholesterol in control: 29% • Improve care coordination • Referral loops closed: 22% • Communication of eye exam results: ? • Decrease patient wait time for specialty referrals: ? • Decrease time to get specialist opinions: ?

  15. Population Health • Increase cancer screening rates in OK • Breast: 43% • Colon: 25.5% • Cervical: 66.5% • Increase immunization rates • Children: 64.6% • Elderly- influenza: 0.69% • Elderly- pneumovax: 9%

  16. MyHealth: Beacon Technologies • Community Decision Support System • Archimedes’ IndiGO • Calculates patient risk and quality-of-life scores • Returns health improvement recommendations • Supports ‘what-if’ experimentation • DocSynergy • Electronic Specialist Consult

  17. Optimize blood pressure management Individualized Guidelines: >Twice the benefit, Save $500,000 Current measures have Plans climbing up this line Individualized Guidelines: Same benefit, Save $750,000 National BP Guideline CONFIDENTIAL 23

  18. DocSynergy™ online consult efficiency

  19. Unexpected Dividends • Results we hadn’t anticipated: • Variety of Specialties participating with good results • Success of consult system-more dependent on the comfort-level of the individual than the specialty • Better relationship between PCPs and specialists • PCPs learn from each interaction, fewer unnecessary consult requests over time • Improved access: those who needed care got it sooner

  20. Out of the Hands of Insurance • Employer Involvement • This is what I am “promoting” today • Employers are the Payers • Not your insurance company • You can’t just let things happen • Transparency is needed • Employers pay for those who don’t/can’t • Need to understand health of your population • Insurance Companies Will Get It • The Company That Solved Healthcare

  21. Real Story About Cost Control • Why Pay For That 2nd MRI • Dr.s need access to all of a patients info • 3rd Generation Machines • Negotiated discounts • Know Hospitals Costs in Your Area • Are you paying Medicare plus 30%, 50%, 100% • Networks as the silver bullet – is it past it’s prime • Cut them out of plan-if out of control

  22. The Real Story About Discounts • Outpatient Surgery • $54,000+ • Good Insurance • Will Give 27% Discount • JUST SAY NO • Changed doctor and hospital - $6500 • Dropped hospital from Plan

  23. The Real Story About Outcomes • Using The Best by Diagnosis • Centers of Excellence • Specialty • Who has the best outcomes – how do you find them • Know Their Readmission Rates • Medicare won’t pay-why should you? • Consider Physician Reimbursement • Year end bonus based on outcomes • Pay more for following best practices

  24. What Can You Do? • Easy for Self-Insureds • Plan Design • Drop Providers if Billing Is Out of Hand • Ask Your Insurance Company • Limit repeated tests-don’t pay • 30 day readmits-don’t pay • Give me info on my population • Are they supporting HIT’s? How? • What Can You Do Today (Even If Not Self-Insured) • Employer interest coalition • Start up

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